DoD Global Respiratory Pathogen Surveillance Program. USAF School of Aerospace Medicine & Defense Health Agency
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1 USAF School of Aerospace Medicine & Defense Health Agency DoD Global Respiratory Pathogen Surveillance Program Cumulative Results Locations 94 Collected 7,600 Tested 7,410 Respiratory Highlights 4 February - 17 February 2018 (Surveillance Weeks 6 & 7) During 4 February - 17 February 2018, a total of 1,536 specimens were collected and received from 70 locations. Results were finalized for 1,421 specimens from 70 locations. The percent influenza positive for Week 6 and 7 were both 40%. The influenza percent positive for the season is approximately 37%. Influenza A 1,911 A(H1N1)pdm A(H1N1)pdm09 Coinfection 34 A(H1N1)pdm09 & A(H3N2) 2 A(H1N1)pdm09 & B 4 A(H3N2) 1,359 A(H3N2) Coinfection 139 A(H3N2) & B 7 A/not subtyped 11 A/not subtyped Coinfection 3 Influenza B* 812 B 742 B & Coinfection 70 Other Respiratory Pathogens 2,246 Adenovirus 77 Chlamydophila pneumoniae 9 Coronavirus 451 Human Bocavirus 13 Human Metapneumovirus 219 Mycoplasma pneumoniae 31 Parainfluenza 135 RSV 405 Rhinovirus/Enterovirus 620 Non-influenza Viral Coinfections 278 Non-influenza Bacterial Coinfections 8 -C. pneumo coinfections (2) -M. pneumo coinfections (6) No Pathogen Detected 2,441 Results are preliminary and may change as more results are finalized. *Influenza B lineages and specimens submitted for sequencing only will be reported in the periodic molecular sequencing reports. Surveillance Week A(H1N1)pdm09 A(H3N2) A/not subtyped A/not subtyped & Rhino/Entero A(H1N1)pdm09 & B A(H1N1)pdm09 & hmpv The World Health Organization (WHO) has released its recommended composition of influenza virus vaccines for use in the northern hemisphere influenza season. The WHO recommends the quadrivalent vaccine contain: an A/Michigan/45/2015 (H1N1)pdm09-like virus; an A/Singapore/INFIMH /2016 (H3N2)-like virus; a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage); and a B/ Phuket/3073/2013-like virus (B/Yamagata/16/88/lineage). For the trivalent vaccine, it is recommended the Influenza B component be a B/Colorado/06/2017-like virus of the B/Victoria/2/87-lineage. Due to considerable variation in the predominant virus type circulating in different regions during the period September 2017 to January 2018 there were two changes recommended from the vaccine components: a new H3N2 component, changed from A/Hong Kong/4802/2014 (H3N2)-like; and a new B Victoria lineage component, changed from a B/Brisbane/60/2008-like virus. (World Health Organization, Recommended composition of influenza virus vaccines for use in the northern hemisphere influenza season, cited 23 February 2018.) Table of Contents Respiratory Highlights Page 1 Results by Region and Location for Specimens Collected during Weeks 6 & 7 Pages 2 & 3 Laboratory Results (Influenza) - Cumulative for Season Page 4 Laboratory Results (Other Respiratory Pathogens) - Cumulative for Season Page 5 Vaccination Status by Beneficiary Type and Service Demographic Summary Geographic Distribution of Influenza Subtype and Activity Level Maps Cumulative Specimen Sequencing A(H1N1)pdm09 & Rhino/Entero A(H3N2) & B A(H3N2) & Adeno A(H3N2) & Corona Week Week Total Page 6 Pages 7 & 8 DoD Global Respiratory Pathogen Surveillance Program Background Page 9 A(H3N2) & Corona & Rhino/Entero A(H3N2) & hmpv A(H3N2) & RSV A(H3N2) & Rhino/Entero B B & Corona B & Corona & Rhino/Entero B & HBoV B & HBoV & hmpv B & hmpv B & RSV B & Rhino/Entero Total 1
2 Table 1. Finalized results by region and location for specimens collected during Weeks 6 & 7 A(H1N1)pdm09 A(H3N2) A/not subtyped A/not subtyped & Rhino/Entero A(H1N1)pdm09 & B A(H1N1)pdm09 & hmpv A(H1N1)pdm09 & Rhino/Entero A(H3N2) & B A(H3N2) & Adeno A(H3N2) & Corona A(H3N2) & Corona & Rhino/Entero Region* Deployed Country 2, Location A EUCOM Aviano AB, Italy Incirlik AB, Turkey Landstuhl RM C, Germany NAS Sigonella, Italy NAVSTA Rota, Spain NSA Naples, Italy RAF Lakenheath, England Ramstein AB, Germany SHAPE, Belgium Spangdahlem AB, Germany USAG Baumholder, Germany USAG Grafenwoehr, Germany USAG Hohenfels, Germany USAG Stuttgart, Germany USAG Vicenza, Italy USAG Wiesbaden, Germany Vilseck AHC, Germany PACOM JR M arianas - Andersen AFB, Guam Kadena AB, Japan M isawa AB, Japan Yokota AB, Japan Region 1 Hanscom AFB, M A USCG Academy, CT Region 2 Ft Drum, NY JB M cguire-dix-lakehurst, NJ USM A - West Point, NY Region 3 Dover AFB, DE JB Andrews, M D JB Langley-Eustis, VA US Naval Academy, M D Region 4 Columbus AFB, M S Eglin AFB, FL Ft Campbell, KY Hurlburt Field, FL M axwell AFB, AL M oody AFB, GA NH Beaufort, SC Robins AFB, GA Seymour Johnson AFB, NC Shaw AFB, SC Tyndall AFB, FL A(H3N2) & hmpv A(H3N2) & RSV A(H3N2) & Rhino/Entero B B & Corona B & Corona & Rhino/Entero B & HBoV B & HBoV & hmpv B & hmpv B & RSV B & Rhino/Entero Adenovirus C. pneumoniae Coronavirus HBoV hmpv Parainfluenza RSV Rhinovirus/Enterovirus Non-Influenza Viral Coinfection Non-Influenza Bacterial Coinfection No Pathogen Total Cont d on page 3 *CONUS locations are based on Health & Human Services regions. Other locations are defined by COCOM. 2
3 Table 1. Finalized results by region and location for specimens collected during Weeks 6 & 7 Region* Region 5 Region 6 Region 7 Region 8 Region 9 Region 10 Total A(H1N1)pdm09 A(H3N2) A/not subtyped A/not subtyped & Rhino/Entero A(H1N1)pdm09 & B A(H1N1)pdm09 & hmpv A(H1N1)pdm09 & Rhino/Entero A(H3N2) & B A(H3N2) & Adeno A(H3N2) & Corona A(H3N2) & Corona & Rhino/Entero A(H3N2) & hmpv A(H3N2) & RSV Scott AFB, IL Wright-Patterson AFB, OH Altus AFB, OK Cannon AFB, NM JBSA Lackland, TX Kirtland AFB, NM Laughlin AFB, TX Little Rock AFB, AR Sheppard AFB, TX Tinker AFB, OK Vance AFB, OK M cconnell AFB, KS Offutt AFB, NE Ellsworth AFB, SD FE Warren AFB, WY Hill AFB, UT M almstrom AFB, M T M inot AFB, ND Peterson AFB, CO USAF Academy, CO Davis-M onthan AFB, AZ Luke AFB, AZ Nellis AFB, NV Eielson AFB, AK Fairchild AFB, WA JB Elmendorf-Richardson, AK M t Home AFB, ID NH Bremerton, WA A(H3N2) & Rhino/Entero B B & Corona B & Corona & Rhino/Entero B & HBoV B & HBoV & hmpv B & hmpv B & RSV B & Rhino/Entero Adenovirus C. pneumoniae Coronavirus HBoV hmpv Parainfluenza RSV Rhinovirus/Enterovirus Non-Influenza Viral Coinfection Non-Influenza Bacterial Coinfection No Pathogen Total *CONUS locations are based on Health & Human Services regions. Other locations are defined by COCOM. 3
4 Cumulative Laboratory Results Link to cumulative results by region and location: Graph 1. Percent influenza positive by week: surveillance year and through Week 7 of the surveillance year Note: Dual influenza coinfections are excluded from this graph. Graph 2. Percent positive for influenza through ILI trends by subtype and beneficiary status through Week 7 of the surveillance year Note: Dual influenza coinfections are excluded from this graph. 4
5 Graph 3. Other positive respiratory pathogens through Week 7 of the surveillance year Graph 4. Percent positive for respiratory pathogens through ILI trends by week and beneficiary status through Week 7 of the surveillance year 5
6 Graph 5. Vaccination status by beneficiary type through Week 7 of the surveillance year (excluding Other beneficiary type) Table 2. ILI by age group through Week 7 of the surveillance year Graph 6. ILI by beneficiary status through Week 7 of the surveillance year Age Group Frequency Percent Demographic Summary Of 7,410 ILI cases, 2,785 are service members (37.6%), 2,528 are children (34.1%), 1,293 are spouses (17.4%), and 804 are retirees and other beneficiaries (10.9%). The median age of ILI cases with known age (n=7,410) is 25 (range 0, 98). 6
7 Map 1. Influenza subtypes and activity level by U.S. region through Week 7 of the surveillance year HI - Region 9 PR - Region 2 AK - Region 10 Map 2. Influenza subtypes and activity level for CENTCOM through Week 7 of the surveillance year Influenza Activity - Past 2 weeks (n = # of submissions) No activity (0% +) or no submissions Low (<25% +) Moderate (25-49% +) High (>50% +) Legend Influenza Results - Cumulative Influenza A(H3N2) Influenza A(H1N1)pdm09 Influenza B Influenza A/not subtyped 7
8 Map 3. Influenza subtypes and activity level by country through Week 7 of the surveillance year (Pacific) Map 4. Influenza subtypes and activity level by country through Week 7 of the surveillance year (Europe) Note - Countries shaded in gray do not contain submitting sites and are only displayed for geographical perspective. Legend Influenza Activity - Past 2 weeks (n = # of submissions) No activity (0% +) or no submissions Low (<25% +) Moderate (25-49% +) High (>50% +) Influenza Results - Cumulative Influenza A(H3N2) Influenza A(H1N1)pdm09 Influenza B Influenza A/not subtyped Table 3. Cumulative specimens submitted for sequencing only by location through Week 7 of the surveillance year. Location Number Number Received Tested Aviano AB, Italy 1 1 Ft Bliss, TX 6 0 Ft Bragg, NC 1 0 Ft Hood, TX 6 3 Keesler AFB, MS Landstuhl RMC, Germany 64 4 NAVSTA Rota, Spain 1 0 NCRM - Walter Reed NMMC, MD 6 2 NMC Portsmouth, VA 5 0 NSA Naples, Italy 1 0 Nellis AFB, NV 1 1 RAF Lakenheath, England 8 0 Ramstein AB, Germany 4 2 SAMMC, TX SHAPE, Belgium 1 1 Tripler AMC, HI 6 0 USAG Baumholder, Germany 1 0 USAG Stuttgart, Germany 5 0 USAG Wiesbaden, Germany 4 0 Vilseck AHC, Germany 4 1 Total
9 USAF School of Aerospace Medicine & Defense Health Agency DoD Global Respiratory Pathogen Surveillance Program Background The DoD-wide program was established by the Global Emerging Infections Surveillance and Response System (GEIS) in The surveillance network includes the Defense Health Agency/Armed Forces Health Surveillance Branch Air Force Satellite Cell (DHA/AFHSB-AF) and U.S. Air Force School of Aerospace Medicine (USAFSAM) (sentinel site respiratory surveillance), the Naval Health Research Center (recruit and shipboard population-based respiratory surveillance), the Naval Medical Research Unit (NAMRU- 3) in Cairo, Egypt, the Naval Medical Research Unit (NAMRU-2) in Phnom Penh, Cambodia, the Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand, the Naval Medical Research Unit (NAMRU-6) in Lima, Peru, and the United States Army Medical Research Unit-Kenya (USAMRU-K) located in Nairobi, Kenya. This work is supported by the Air Force and GEIS Operations, a Division of the Armed Forces Health Surveillance Branch (AFHSB). Sentinel Site Surveillance In 1976, the U.S. Air Force Medical Service began conducting routine, global, laboratory-based, influenza surveillance. Air Force efforts expanded to DoD-wide in DHA/AFHSB-AF and USAFSAM manages the surveillance program that includes global surveillance among DoD beneficiaries at 79 sentinel sites (including deployed locations) and many non-sentinel sites (please see map below). Collaborating partner laboratories include five DoD overseas medical research laboratories (AFRIMS, NAMRU-2, NAMRU-3, NAMRU-6, USAMRD-K) who collect specimens from local residents in surrounding countries that may not otherwise be covered in existing surveillance efforts. Additionally, the Naval Health Research Center (NHRC) in San Diego, CA collects specimens from DoD recruit training centers and conducts surveillance along the Mexico border. Landstuhl Regional Medical Center (LRMC) and Tripler Army Medical Center (TAMC) assist the program by processing DoD specimens for the EUCOM region and the State of Hawaii, respectively. EUCOM respiratory data is obtained from LRMC and incorporated into our weekly report. This process seeks to provide more timely results and efficient transport of specimens. Available on our website (listed below) is a list of previous weekly surveillance reports, program information (including an educational briefing and instruction pamphlets for clinic staff), and a dashboard containing respiratory data for our sentinel sites. Errata: For Public Health Services ; DSN For Laboratory Services ; DSN USAFSAM.PHRFlu@us.af.mil Collaborating Partners In addition to all participating DoD military sentinel sites, collaborating laboratories and medical centers (described above) may be further understood by reviewing the sites website. Click on the sites icon to be directed to their webpage. 9
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